Loading...
HomeMy WebLinkAboutApplication & Supporting Docsl F,r�yE. 1 ytyl INOW ARATEA *f Y�J IA A6®Sa HEARING BOARDS 444 SW 2nd Avenue, 7t" Floor • Miami, Florida 33130 Telephone 305-416-2030 • Fax 305-416-2035 www.miamigov.com/hearing boards SPECIAL EXCEPTION Welcome to Hearing Boards! This application is intended to serve as a guide in assisting you with our public hearing process. Please feel free to contact us at the number above, should you have any questions. The deadline to file the complete application with supporting documents is the first five working days of each month from 8:00 am until 3:00 pm, except on the fifth day, at 12:00 pm. The application submittal date is the date stamped by Hearing Boards' staff on this page. The responses to this application must be typed and signed in black ink. Please note that pursuant to Section 1304.2.2 of the Miami Zoning Ordinance, no application shall be deemed to have been filed unless and until the application shall have been completed. All pertinent and accurate information/documentation; i.e., the plans, reports, exhibits, shall be presented at the time of filing, in addition to the paid receipt. The applicant is responsible for the accuracy of the information contained in the application and all supporting materials. Should you wish, you could bring the materials to our office for review before the deadline to ensure completeness. You will be responsible, if needed, to bring an interpreter for the English language to any presentation before city boards, committees and the city commission. A valid power of attorney will be required if neither applicant or legal counsel representing the applicant execute the application or desire to make a presentation before city boards, committees and the city commission. All documents, reports, studies, exhibits (8 Y2 x11") or other materials submitted during this process will be kept as part of the record. An additional fee to record Zoning Board resolutions will be charged, and it is determined contingent upon fees charged at the time of recordation by the Miami -Dade County Recorder's Office at 22 NW First Street, First Floor. Upon arrival, ask for a certified copy of the Zoning Board resolution. They will keep the original, but please have them mail it to us at the address above, and bring the certified copy to our office. Copies of City Commission resolutions/ordinances can be obtained at our website through the "Legislative Hub", or for certified copies, please contact the Office of the City Clerk at 305-250-5360 or at 3500 Pan American Drive. ORDINANCE NO. 11469, CODIFIED IN CHAPTER 2, ARTICLE VI OF THE CITY CODE STATES THAT ANY PERSON WHO RECEIVES COMPENSATION, REMUNERATION OR EXPENSES FOR CONDUCTING LOBBYING ACTIVITIES TO REGISTER AS A LOBBYIST WITH THE CITY CLERK, PRIOR TO ENGAGING IN LOBBYING ACTIVITIES BEFORE CITY STAFF, BOARDS, COMMITTEES AND THE CITY COMMISSION. A COPY OF SAID ORDINANCE IS AVAILABLE IN THE OFFICE OF THE CITY CLERK (MIAMI CITY HALL), LOCATED AT 3500 PAN AMERICAN DRIVE, MIAMI, FLORIDA, 33133. Ordinance No. 12918 states that each person or entity requesting approval, relief or other action from the City Commission or any of its boards, authorities, agencies, councils or committees regarding any issue, shall disclose at the commencement (or continuance) of the public hearing(s) on the issue, any consideration provided or committed, directly or on its behalf, for an agreement to support or withhold objection to the requested approval, relief or action. The Disclosure of Consideration Provided or Committed for Agreement to Support or Withhold Objection Affidavit included in this package must be submitted with the application. The applicant must, at the commencement of any public hearing on the issue, if there is any disclosure to report, read the disclosure into the record. Also, the applicant must supplement the affidavit if there is any new information or additional information to disclose. Applications given to customers do not constitute action from the City of Miami without plans review and written comments from the Office of Zoning. Rev. 12-16-08 Please refer to Article 19 of the Miami Zoning Ordinance for Special Exception information. 1. Applicant name(s): Jacques Barbera on behalf of Aquarela LLC 2. Subject property address(es) and folio number(s): _401 SW 17 Avenue, Miami, FL - 33135 01-4102-014-0050 , 01-4102-014-0060 3. One (1) original survey dated within six (6) months from the date of application prepared by a State of Florida registered land surveyor. 4. One (1) original 24x36" plan, signed and sealed by a State of Florida registered architect or engineer showing property boundaries and proposed structure(s), parking, landscaping, etc.; building elevations and dimensions and computations of lot area and building spacing. 5. Bring the original 2436" plan to Hearing Boards to be stamped, dated and initialed by a designee and then by the following departments before the application is filed: a) Department of Public Works on the 8th Floor; b) Office of Zoning on the 4th Floor; c) Planning Department on the 3rd Floor. Note: If comments are generated by any of the above, you must return to the architect or engineer to have those comments incorporated into the plans, and you must begin #5 again. Plans are to be submitted to Zoning for first time review starting from the 8th through the 20th of each month. Zoning will not be accepting first-time review plans after the 20th day of the month. 6. After obtaining signatures from the above departments, two (2) 11 x17" and one (1) 8'/2x11" copies of the original plan, in addition to the survey. 7. Original and current Zoning Referral and Zoning Write -Up signed by Office of Zoning designee. 8. The subject property(ies) cannot have any open code enforcement/lien violations, unless the request, if granted, would remedy the violation. 9. Copy of the lobbyist registration processed by the Office of the City Clerk, if applicable. 10. At least two photographs showing the entire property showing land and improvements. 11. A clear and legible copy of the recorded warranty deed and tax forms of the most current year showing the present owner(s) and legal description of the property. 12. A clear and legible copy of the subject property address(es) and legal description(s) on a separate sheet, labeled as "Exhibit A", to match with the current survey's legal description. 13. Affidavit of Authority to Act and the Disclosure of Ownership of all owners and contract purchasers, if applicable, of the subject property (see pages 4 and 5). 14. Original Disclosure of Consideration Provided or Committed for Agreement to Support or Withhold Objection Affidavit. 15. Certified list of owners of real estate within 500 feet of the subject property (see pages 6 and 7). 2 Rev. 12-16-08 16. For all corporations and partnerships indicated: a) Articles of Incorporation; b) Certificate from Tallahassee showing good standing, less than one (1) year old; c) Corporate Resolution or a Power of Attorney signed by the secretary of the authorizing the person who signed the application to do so; d) Non-profit organizations: A list of Board of Directors less than one (1) year old. 17. What is the acreage of the project/property site? 0,22 Acres Corporation 18. What is the purpose of this application/nature of proposed use? Condominium Residential Reduction in required residential Parking 19. Is the property within the boundaries of a historic site, historic district or archeological zone? Please contact the Planning Department on the 3rd Floor for information. No 20. Is the property within the boundaries of an Environmental Preservation District? Please contact the Planning Department on the 3rd Floor for information. No 21. Cost of processing according to Section 62-156 of the Miami City Code*: a. Special Exception requiring automatic City Commission review $ 2,000.00 b. Special Exception $ 800.00 c. Extension of time for Special Exception $ 500.00 Cl. Nonsubstantial modification $ 400.00 Public hearing and public meeting mail notice fees, including cost of handling and mailing per notice $ 3.50 Surcharge equal to applicable fee from item above, not to exceed eight hundred dollars ($800.00) except from agencies of the city; such surcharge to be refunded to the applicant if there is no appeal from the applicant or a property owner within five hundred (500) feet of the subject property. *Pursuant to Ordinance 12719, all planning and zoning fees in excess of $25,000.00, shall be paid in the form of a certified check, cashier's check, or money order. Signatuf;__.I-- Mailing Address 701 Brickell Avenue, Suite 1460 Aqy. arela LLC Name Jacques Barbera MIAMI,Florida 33131 Telephone 772-538-9499 E-mail Herveb@barinvestms.com STATE OF FLORIDA -- COUNTY OF MIAMI-DADE The foregoing was acknowledged before me this .2 day of 141"w 20oq , by 40,165 4.44.4.644 who is a(n) individual/partner/agent/corporation of -'9©44,&Sut . L6 C. a(n) individual/partnership/corporation. He/She is personally known or who has produ as identification and who did (did not) take an o th. /f / JOSE ANGEL GONZALEZ (Stamp) c�',- ": MY COMMISSION # DD837510 Signature EXPIRES November 12, 2012 (407)390.0153 MorldallolarySerwce.com 3Rev. 12-16-08 CORPORATE RESOLUTION OF AQUARELA LLC A Florida Limited Liability Company Meeting of members The resolution presented and approved by each member of Aquarela LLC on March 4, 2009, confirms that Mr. Jacques Barbera, as a managing member of Aquarela LLC, has the full power of signing any legal, permitting and technical application with the city of Miami on behalf of Aquarela LLC. IN WITNESS WHEREOF, the parties hereto have caused their names to be written below as of the day first above. ADOPTED by the member of the company, on the 04`h day of March, 2009 100% Owner of the company BMP LLC, By: Jacques Barbera CORPORATE RESOLUTION OF AQUARELA LLC A Florida Limited Liability Company Meeting of members The resolution presented and approved by each member of Aquarela LLC on March 4, 2009, confirms that Mr. Jacques Barbera, as a managing member of Aquarela LLC, has the full power of signing any legal, permitting and technical application with the city of Miami on behalf of Aquarela LLC. IN WITNESS WHEREOF, the parties hereto have caused their names to be written below as of the day first above. ADOPTED by the member of the company, on the 04th day of March, 2009 100% Owner of the company JBBS LLC, Stefano Benvenuti CORPORATE RESOLUTION OF AQUARELA LLC A Florida Limited Liability Company Meeting of members The resolution presented and approved by each member of Aquarela LLC on March 4, 2009, confirms that Mr. Jacques Barbera, as a managing member of Aquarela LLC, has the full power of signing any legal, permitting and technical application with the city of Miami on behalf of Aquarela LLC. IN WITNESS WHEREOF, the parties hereto have caused their names to be written below as of the day first above. ADOPTED by the member of the company, on the 04th day of March, 2009 100% Owner of the company L&K CREATION LLC, By Philippe Kalifa AFFIDAVIT OF AUTHORITY TO ACT Before me this day, the undersigned personally appeared Jacques Rarbara For Aquarela LLC, who being by me first deposes and says: 1. That he/she is the owner or the legal representative of the owner, submitting the public hearing application as required by the Code of the City of Miami, Florida, affecting the real property located in the City of Miami, as listed on the foregoing pages. 2. That all owners who he/she represents, if any, have given his/her full and complete permission for him/her to act in his/her behalf for the change or modification of a classification or regulation of zoning as set out in the foregoing petition, ❑ including or ❑ not including responses to day to day staff inquires. 3. That the foregoing and following pages are part of this affidavit and contain the current names, mailing addresses, telephone numbers and legal descriptions of the real property of which he/she is the owner or legal representative. 4. That the facts, as represented in the application and documents submitted in conjunction with this affidavit, are true and correct. Further Affiant sayeth not. Jacques Barbera Applicant(s) Name Applicant(s) Signature Jacques Barbera On behalf Aquaret.a LLC STATE OF FLORIDA -- COUNTY OF MIAMI-DADE The foregoing was acknowledged before me this A day of WAe,I/A 20 09 , by 43d &Qd6 s I& -4'd4'54 a who is a(n) individual/partner/agent/corporation of AQM*644 , L401 a(n) individual/partnership/corporation. He/She is personally known to me or who has produced 1:arrtoa9rraJ as identification and who did di ) take aryQath (Stamp) loj;%'y � ,_i JOSE ANGEL GONZALEZ Signa e -' MY COMMISSION # DD837510 EXPIRES November 12, 2012 (407)398-0153 Floddallotary$ervacom Rev. 12-16-08 DISCLOSURE OF OWNERSHIP 1. List the owner(s) of the subject property and percentage of ownership. Note: The Miami City Code requires disclosure of all parties having a financial interest, either direct or indirect, with respect to a presentation, request or petition. Accordingly, disclosure of shareholders of corporations, beneficiaries of trusts, and/or any other interested parties, together with their address(es) and proportionate interest are required. Please supply additional lists, if necessary. Owner's Name(es) Jacques Barbera on behalf of Aquarela LLC, Percentage Of Ownership: 100% owner of JBBS LLC, Stefano Benvenuti - (33,33% of Aquerela LLC,) 100% owner of L&K CREATION LLC, Philippe Kalifa - (33,33% of Aquerela LLC,) 100% owner of BMP LLC, Jacques Barbera - (33,34% of Aquerela LLC,) Subject Property Address(es) 401 SW 17 AVE — MIAMI - 33135 2. Street address and legal description of any property owned by any and all parties listed in answer to question #1 located within 500 feet of the subject property. Please supply additional lists, if applicable. Street Address N/A Jacques Barbera on behalf of Aquarela LLC, Owner(s) or Attorney Name STATE OF FLORIDA COUNTY OF MIAMI-DADE Legal Description N/A 1 Owner(s) or Attorney Signature The foregoing was acknowledged before me this day of 19,edll 20_o, byg% a 4a as s 4,9,e,6a C Q who is a(n) individual/partner/agent/corporation of AooaR ecA , 444 a(n) individual/partnership/corporation. He/She is personally known to a or v has produced 1`a�Nr�r.��r�o•� as identification and who d (di ot) e n o,, (Stamp) JOSE ANGEL GONZALEZ "c MY COMMISSION # DD837510 �� r• EXPIRES November 12, 2012 598 407 ,0153 F10N8N018 $@rVM.0M S EXIB IT "A" PROPERTY ADDRESS: 401 SW 17 AVENUE - MIAMI - FLORIDA -33135 LEGAL DESCRIPTION: Lot 5 and 6, of " BLOCK 4, OSCEOLA PARK AND LOT 1, BLOCK 107, LAWRENCE ESTATE" according to the plat thereof as recorded In Plat Book 7, at Page 151 of the Public Records of Mloml—Dade County, Florida. Less: A portion of Lots 5 and 6 of "A subdivision of Block 4, OSCEOLA PARK and Lot i, Block 107, LAWRENCE ESTATES", according to the Plat thereof, recorded in Plot Book 7, at Page 151, of the Public Records of Miami—Dade County, Florida, being more particularly described as follows: Begin at the Northwest carrier of said Lot 5; thence run North 87'43'49" East, along the North line of said Lot 5, for a distance of 31.54 feet to the Point of Curvature of a circular curve concave to the Southeast; thence run Southwesterly along are of said curve concave to the Southeast, having a radius of 20.00 feet, througt a central angle of 87'13'28', for an arc distance of 30.15 feet to the Point of compound curvature with the arc of a circular curve to the left; thence run Southerly, along the are of said circular curve to the left, having a radius of 1874.86 feet, through a central angle of 02'28'14', for an are distance of 81.02 feet to the Point of Intersection with the South line of said Lot 6: thence run South 87.43'46" West, along the South line of sold Lot 6, for a distance of 10.00 feet to he Southwest corner of said Lot 6; thence run North 01'58'42" West along the West line of said Lots 6 and 5, for a distance of 100.02 feet to the Point of Beginning. www.sunbiz.org - Department of State Home Contact Us E -Filing Services Previous on List Next on List Return To List No Events No Name History Detail by Entity Name Florida Limited Liability Compan AQUARELA LLC Filing Information Document Number L04000066205 FEI Number 201619385 Date Filed 09/08/2004 State Fl- Status LStatus ACTIVE Principal Address 701 BRICKELL AVE STE 1460 MIAMI FL 33131 Changed 01/11/2007 Mailing Address 701 BRICKELL AVE STE 1460 MIAMI FL 33131 Changed 01/11/2007 Registered Agent Name & Address BAR INVEST MANAGEMENT SERVICES LLC 701 BRICKELL KEY DRIVE STE 1460 MIAMI FL 33131 US Name Changed: 08/21/2006 Address Changed: 08/21/2006 Manager/Member Detail Name & Address Title MGR BARBERA,JACQUES 520 BRICKELL KEY DRIVE, SUITE 0-305 MIAMI FL 33131 Annual Reports Report Year Filed Date 2006 04/05/2006 2007 01/11/2007 Document Searches Page 1 of 2 Forms Help Entity Name Search http://www. sunbiz. org/scripts/cordet. exe?action=DETFIL&inq_doc_number=L040000662... 1/29/2009 www.sunbiz.org - Department of State Page 1 of 2 Home Contact Us E -Filing Services Document Searches Forms Help Previous on List Next on List Return To List No Events No Name History Detail by Entity Name Florida Limited Liability Compan BMP, LLC Filing Information Document Number L04000004423 FEI Number 542152548 Date Filed 01/15/2004 State FL Status ACTIVE Principal Address 701 BRICKELL AVE # 1460 MIAMI FL 33131 Changed 03/08/2006 Mailing Address 701 BRICKELL AVE # 1460 MIAMI FL 33131 Changed 03/08/2006 Registered Agent Name & Address BARBERA,JACQUES 701 BRICKELL AVE, STE 1460 MIAMI FL 33131 US Name Changed: 03/08/2006 Address Changed: 03/08/2006 Manager/Member Detail Name & Address Title MGRM BARBERA,JACQUES 1501 COLLINS AVE, 3RD FLOOR MIAMI BEACH FL 33139 Annual Reports Report Year Filed Date 2006 03/08/2006 2007 02/16/2007 Entity Name Search http://sunbiz.org/scripts/eordet.exe?action=DETFIL&inq_doc_number=LO4000004423 &in... 3/4/2009 www.sunbiz.org - Department of State Home Contact Us E -Filing Services Previous on List Next on List Return To List No Events No Name History Detail by Entity Name Florida Limited Liability Company JBBS, LLC Filing Information Document Number L04000068037 FEI Number N/A Date filed 09/17/2004 State FL Status ACTIVE Principal Address 2100 SALZEDO STREET, SUITE 300 CORAL GABLES FL 33134 Mailing Address 2100 SALZEDO STREET, SUITE 300 CORAL GABLES FL 33134 Registered Agent Name & Address ARAZOZA & FERNANDEZ-FRAGA, P.A. 2100 SALZEDO STREET, SUITE 300 CORAL GABLES FL 33134 Manager/Member Detail Name & Address Title MGR BENVENUTI,STEFANO 725 VILABELLA AVE. CORAL GABLES FL 33146 Annual Reports Report Year Filed Date 2006 06/16/2006 2007 03/26/2007 2008 04/29/2008 Document Images 04/29/2008 -- ANNUAL REPORT 03/26/2007 -- ANNUAL REPORT 06/16/2006_-- ANNUAL REPORT Document Searches View image in PDF format View image in PDF format View image in PDF format Page I of 2 Forms Help Entity Name Search http://sunbiz. org/scripts/eordet. exe?action=DETFIL&inq_doe—number=LO400006803 7&in... 3/4/2009 www.sunbiz.org - Department of State Page I of 2 Home Contact Us E -Filing Services Document Searches Forms Help Previous on List Next on List Return To List No Events No Name History Detail by Entity Name Florida Limited Liability Compan L & K CREATION, LLC Filing Information Document Number L05000053655 FEI Number 202923834 Date Filed 05/31/2005 State FL Status ACTIVE Principal Address 450 ALTON RD. 2507 MIAMI BEACH FL 33139 Changed 01/27/2009 Mailing Address 450 ALTON RD. 2507 MIAMI BEACH FL 33139 Changed 01/27/2009 Registered Agent Name & Address DE LA VEGA AND MORGADE, P.A. ONE ALHAMBRA PLAZA STE 1415 CORAL GABLES FL 33134 US Name Changed: 02/09/2007 Address Changed: 02/09/2007 Manager/Member Detail Name & Address Title MGR KALIFA, PHILIPPE 450 ALTON RD, APT 2507 MIAMI BEACH FL 33139 Annual Reports Report Year Filed Date 2007 02/09/2007 2008 01/08/2008 Entity Name Search http://sunbiz.org/scripts/cordet. exe?action=DETFIL&inq_doc_number=L05 00005 365 5 &in... 3/4/2009 i nriii rriir iriii irrrr ii�rr ir�rr iiia ilii �rri OR bk122790 f'ss 33 S9 3546r a5) RECORDED 11103/2004 14:01=44 DEED DDC TAX 5,4f10.00 Pl4pitt+ed1yandre uMJQ: HARVEY RUVIHr CLERK OF COURT Urban Title, LLC MIAMI-DADE COUNTY, FLORIDA 5900 S.W. 73rd Street Suite 304 Miami, Florida 33143 File Number: UT04-068 [Space Above This Line For Recording beta] //►► Warranty Deed This Warranty Deed made thAlAday of October, 2004 between Jose M. Serrano and Simona Tessaro, his wife, and Umberto Tessaro and Egista C. Tessaro, his wife whose post office address is Aquarele,1?5� (�� � •y.� • i n 2+ � C-4R +43•tp FL �.� 1 �----- , FloridalLC, a Florida limited liability company whose, post office address is 520 Brickell Key _ grantor, and Miami, o33131, grantee: Drive, Suite 0-305, (Whenever used herein the tans "grantor" and "grantee" include all the parties to this instrument and the heirs, legal representatives, and assigns of individuals, and the successors and assigns of corporations, trusts and trustees) Witnesseth, that said grantor, for and in consideration of the sum of TEN AND NO/100 DOLLARS ($10,00) and other good and valuable considerations to said grantor in hand paid by said grantee, the receipt whereof is hereby acknowledged, has granted, bargained, and sold to the said grantee, and grantee's heirs and assigns forever, the following described land, situate, lying and being in Miami-Dade County, Florida to-wit: Lot 5 and 6, of BLOCK 4, OSCEOLA PARK AND LOT 1, BLOCK 107, LAWRENCE ESTATE, according to the Plat thereof recorded in Plat Book 7, at Page 151, of the Public Records of Miami. Dade County, Florida. Less A portion of Lots 5 and 6 of a subdivision of Block 4, OSCEOLA PARK and Lot 1, Block 107, LAWRENCE ESTATE, according to the Plat thereof, recorded in Plat Book 7, at Page 151, of the Public Records of Miami -Dade County, Florida, being more particularly described as follows: Begin at the Northwest corner of said Lot 5; thence run North 870 43'49" East, along the North line of said Lot 5, for a distance of 31.64 feet to the Point of Curvature of a circular curve concave to the Southeast; thence run Southwesterly along the are of said circular curve concave to the Southeast, having a radius of 20.00 feet, through a central angle of 87' 13'28", for an arc distance of 30.15 feet to the Point of compound curvature with the arc of a circular curve to the Left; thence run Southerly, along the are of said circular curve to the Left, having a radius of 1874.86 feet, through a central angle of 02' 28'1.4", for an are distance of 81.02 feet to the Point of Intersection with the South line of sold Lot 6; thence run South 87' 43'46" West, along the South line of said Lot 6, for a distance of 10.00 feet to the Southwest corner of said Lot 6; thence run North 01° 58'42" West along the West line of said Lots 6 and 5, for a distance of 100.02 feet to the Point of Beginning. Parcel Identification Number: 01-4102-014-0050 Parcel identification Number: 01-4102-014-0060 Subject to taxes for 2004 and subsequent years; covenants, conditions, restrictions, easements, reservations and limitations of record, if any; without re -imposing same. Together with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining, To Have and to Hold, the same in fee simple forever. And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple; that the grantor has good right and lawful authority to sell and convey said land; that the grantor hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever; and that said land is free of all encumbrances, except taxes accruing subsequent to December 31, 2003, In Witness Whereof, grantor has hereunto set grantor's hand and seal the day and year first above written. DoubleTlmee Signed, scaled and delivered in our presence: I►�7 State of Florida County of Miami -Dade OR BK 22790 PG Z346 LAST PAGE (Seal) JoeM.S a (Seal) Evista C. sar The foregoing instrument was acknowledged before me this. A -ay of October, 2004 by Jose M. Serrano, Simona Tessaro, Umberto Tessaro and Egista C. Tessaro, who L] are personally known or [X] have produced a driver's license as identification. [Notary Seal] Notary ublic Pranduo J Onyp p MY '"'On DD102044 Printed Name: EMpirb Mrroh 21, 2008 My Commission Expires: Warranty peed - Page 2 DoubieTimee G4tY_Old! 0 �w ' CITY OFMIAMI T-1 DISCLOSURE OF CONSIDERATION PROVIDED OR COMMITTED FOR AGREEMENT TO co. rio4�� SUPPORT OR WITHHOLD OBJECTION The City of Miami requires any person or entity requesting approval relief or other action from the City Commission or any of its boards, authorities, agencies, councils or committees, to disclose at the commencement (or continuance) of the hearing(s) on the issue, any consideration provided or committed, directly or on its behalf, to any entity or person for an agreement to support or withhold objection to the requested approval, relief or action. "Consideration" includes any gift, payment, contribution, donation, fee, commission, promise or grant of any money, property, service, credit or financial assistance of any kind or value, whether direct or implied, or any promise or agreement to provide any of the foregoing in the future. Individuals retained or employed by a principal as a lobbyist as defined in Sec. 2-653, and appearing before the City Commission or any of its boards, authorities, agencies, councils or committees solely in the capacity of a lobbyist and not as the applicant, or owners, legal representative are not required to fill out this form. NAME: Jacques Barbera (First Name) (Middle) (Last Name) HOME ADDRESS: 401 SW 17 Avenue (Address Line 1) CITY HOME PHONE: Miami STATE: Florida ZIP: 33135 CELLPHONE: (772) 538-9499 FAX: (305) 538-4960 EMAIL: thierryb@barinvest.com BUSSINESS or APPLICANT or ENTITY NAME Aquarela LLC BUSINESS ADDRESS: 701 Brickell Avenue, suite 1460, MIAMI 33131 (Address Line 1) (Address Line 2) 1. Please describe the issue for which you are seeking approval, relief or other action from the City Commission, board, authority, agency, council, or committee. N/A N/A N/A 2. Has any consideration been provided or committed, directly or on your behalf, to any entity or person for an agreement to support or withhold objection to the requested approval, relief or action? YES Q NO If your answer to Question 2 is No, do not answer questions 3, 4 & 5 proceed to read and execute the Acknowledgment. If your answer to Question 2 is Yes, please answer questions 3, 4 & 5 and read and execute the Acknowledgement. Doc. No.: 86543 3. Please provide the name, address and phone number of the person(s) or entities to whom consideration has been provided or committed. Name Address Phone# a. -N /A b. N /A C. * Additional names can be placed on a separate page attached to this form. 4. Please describe the nature of the consideration. N/A 5. Describe what is being requested in exchange for the consideration. N /A N/A IF ACKNOWLEDGF,MENT OF COMPLIANCE I hereby acknowledge that it is unlawful to employ any device, scheme or artifice to circumvent the disclosure requirements of Ordinance 12918 and such circumvention shall be deemed a violation of the Ordinance; and that in addition to the criminal or civil penalties that may be imposed under the City Code, upon determination by the City Commission that the foregoing disclosure requirement was not fully and timely satisfied the following may occur: 1. the application or order, as applicable, shall be deemed void without further force or effect; and 2. no application from any person or entity for the same issue shall be reviewed or considered by the applicable board(s) until expiration of a period of one year after the nullification of the application or order. PERSON SUBMITTING ING DISCLOSURE: Signature JA"des SA((BEXA 00 BE944C o" AquApt;.•)-A I—LC Print Name + Stil,orn to and subscribed before me-. this......................._A........ ...... ........_day 4f............._���4 L.............._..............................._......_.._, 2f)D...__9...._..... The foregoing anstrumc nt Inas acknnil,lecl ed before me by •,7" v� s �'✓�z.•;s , t A .. ....., ivho has produced ...._4R&b....... as identifteation anchor is, personally known to nne and tivho did1did not take an oath. STATE OFFLORIDA / CITY OF' MIAN/I1 w MY C;ONQVIISSION---Notary k!"YP'�% JOSE ANGEL GONZALE' EXPIRES:...//`!_ri-.1_Z- •► �✓ G-yoNtaL�L :°, MY COMMISSION # DD8375- Print Name' ' EXPIRES November 12,201 Enclosure(s) (407)398-0153 Florddallotary8ery".___ Doc. No.:86543 Page 7 0